This paper reviews research literature on Diamond Open Access (DOA) journals - sometimes also called Platinum Open Access - that was produced after this journal segment started to become a priority in European research policy around 2020. It contextualizes the current science policy debate, critically examines different understandings of DOA, and reviews studies on the role of such journals in scholarly communication. Most existing research consists of quantitative studies focusing on aspects such as the number of DOA journals, their publication output, the diversity of the landscape in terms of subject areas, languages, publishing entities, indexing in major databases, awareness and perception among scholars, cost analyses, as well as insights into the internal operations of DOA journals. The review shows that research on DOA journals is partly influenced by the science policy discourse in at least two ways: first, through the normativity inherent in that discourse, and second, through the temporality of policy-driven research of practical relevance, which leaves important aspects of the phenomenon understudied. Moreover, research on the DOA journal landscape has implications beyo
Southeast Asia is a geopolitically and socio-economically significant region with unique challenges and opportunities. Intensifying progress in generative AI against a backdrop of existing health security threats makes applications of AI to mitigate such threats attractive but also risky if done without due caution. This paper provides a brief sketch of some of the applications of AI for health security and the regional policy and governance landscape. I focus on policy and governance activities of the Association of Southeast Asian Nations (ASEAN), an international body whose member states represent 691 million people. I conclude by identifying sustainability as an area of opportunity for policymakers and recommend priority areas for generative AI researchers to make the most impact with their work.
Global rates of mental health concerns are rising, and there is increasing realization that existing models of mental health care will not adequately expand to meet the demand. With the emergence of large language models (LLMs) has come great optimism regarding their promise to create novel, large-scale solutions to support mental health. Despite their nascence, LLMs have already been applied to mental health related tasks. In this paper, we summarize the extant literature on efforts to use LLMs to provide mental health education, assessment, and intervention and highlight key opportunities for positive impact in each area. We then highlight risks associated with LLMs' application to mental health and encourage the adoption of strategies to mitigate these risks. The urgent need for mental health support must be balanced with responsible development, testing, and deployment of mental health LLMs. It is especially critical to ensure that mental health LLMs are fine-tuned for mental health, enhance mental health equity, and adhere to ethical standards and that people, including those with lived experience with mental health concerns, are involved in all stages from development through
Motivation: Society's dependence on Open Source Software (OSS) and the communities that maintain the OSS is ever-growing. So are the potential risks of, e.g., vulnerabilities being introduced in projects not actively maintained. By assessing an OSS project's capability to stay viable and maintained over time without interruption or weakening, i.e., the OSS health, users can consider the risk implied by using the OSS as is, and if necessary, decide whether to help improve the health or choose another option. However, such assessment is complex as OSS health covers a wide range of sub-topics, and existing support is limited. Aim: We aim to create an overview of characteristics that affect the health of an OSS project and enable the assessment thereof. Method: We conduct a snowball literature review based on a start set of 9 papers, and identify 146 relevant papers over two iterations of forward and backward snowballing. Health characteristics are elicited and coded using structured and axial coding into a framework structure. Results: The final framework consists of 104 health characteristics divided among 15 themes. Characteristics address the socio-technical spectrum of the communi
Objective: To enhance health literacy and accessibility of health information for a diverse patient population by developing a patient-centered artificial intelligence (AI) solution using large language models (LLMs) and Fast Healthcare Interoperability Resources (FHIR) application programming interfaces (APIs). Materials and Methods: The research involved developing LLM on FHIR, an open-source mobile application allowing users to interact with their health records using LLMs. The app is built on Stanford's Spezi ecosystem and uses OpenAI's GPT-4. A pilot study was conducted with the SyntheticMass patient dataset and evaluated by medical experts to assess the app's effectiveness in increasing health literacy. The evaluation focused on the accuracy, relevance, and understandability of the LLM's responses to common patient questions. Results: LLM on FHIR demonstrated varying but generally high degrees of accuracy and relevance in providing understandable health information to patients. The app effectively translated medical data into patient-friendly language and was able to adapt its responses to different patient profiles. However, challenges included variability in LLM responses a
Mobile health has the potential to revolutionize health care delivery and patient engagement. In this work, we discuss how integrating Artificial Intelligence into digital health applications-focused on supply chain, patient management, and capacity building, among other use cases-can improve the health system and public health performance. We present an Artificial Intelligence and Reinforcement Learning platform that allows the delivery of adaptive interventions whose impact can be optimized through experimentation and real-time monitoring. The system can integrate multiple data sources and digital health applications. The flexibility of this platform to connect to various mobile health applications and digital devices and send personalized recommendations based on past data and predictions can significantly improve the impact of digital tools on health system outcomes. The potential for resource-poor settings, where the impact of this approach on health outcomes could be more decisive, is discussed specifically. This framework is, however, similarly applicable to improving efficiency in health systems where scarcity is not an issue.
Selecting the right monitoring level in Remote Patient Monitoring (RPM) systems for e-healthcare is crucial for balancing patient outcomes, various resources, and patient's quality of life. A prior work has used one-dimensional health representations, but patient health is inherently multidimensional and typically consists of many measurable physiological factors. In this paper, we introduce a multidimensional health state model within the RPM framework and use dynamic programming to study optimal monitoring strategies. Our analysis reveals that the optimal control is characterized by switching curves (for two-dimensional health states) or switching hyper-surfaces (in general): patients switch to intensive monitoring when health measurements cross a specific multidimensional surface. We further study how the optimal switching curve varies for different medical conditions and model parameters. This finding of the optimal control structure provides actionable insights for clinicians and aids in resource planning. The tunable modeling framework enhances the applicability and effectiveness of RPM services across various medical conditions.
Electronic Health Record (EHR) has become an essential tool in the healthcare ecosystem, providing authorized clinicians with patients' health-related information for better treatment. While most developed countries are taking advantage of EHRs to improve their healthcare system, it remains challenging in developing countries to support clinical decision-making and public health using a computerized patient healthcare information system. This paper proposes a novel EHR architecture suitable for developing countries--an architecture that fosters inclusion and provides solutions tailored to all social classes and socioeconomic statuses. Our architecture foresees an internet-free (offline) solution to allow medical transactions between healthcare organizations, and the storage of EHRs in geographically underserved and rural areas. Moreover, we discuss how artificial intelligence can leverage anonymous health-related information to enable better public health policy and surveillance.
The growing demand for home healthcare calls for tools that can support care delivery. In this study, we explore automatic health assessment from voice using real-world home care visit data, leveraging the diverse patient information it contains. First, we utilize Large Language Models (LLMs) to integrate Subjective, Objective, Assessment, and Plan (SOAP) notes derived from unstructured audio transcripts and structured vital signs into a holistic illness score that reflects a patient's overall health. This compact representation facilitates cross-visit health status comparisons and downstream analysis. Next, we design a multi-stage preprocessing pipeline to extract short speech segments from target speakers in home care recordings for acoustic analysis. We then employ an Audio Language Model (ALM) to produce plain-language descriptions of vocal biomarkers and examine their association with individuals' health status. Our experimental results benchmark both commercial and open-source LLMs in estimating illness scores, demonstrating their alignment with actual clinical outcomes, and revealing that SOAP notes are substantially more informative than vital signs. Building on the illness
The Oregon Health Insurance Experiment (OHIE) offers a unique opportunity to examine the causal relationship between Medicaid coverage and happiness among low-income adults, using an experimental design. This study leverages data from comprehensive surveys conducted at 0 and 12 months post-treatment. Previous studies based on OHIE have shown that individuals receiving Medicaid exhibited a significant improvement in mental health compared to those who did not receive coverage. The primary objective is to explore how Medicaid coverage impacts happiness, specifically analyzing in which direction variations in healthcare spending significantly improve mental health: higher spending or lower spending after Medicaid. Utilizing instrumental variable (IV) regression, I conducted six separate regressions across subgroups categorized by expenditure levels and happiness ratings, and the results reveal distinct patterns. Enrolling in OHP has significantly decreased the probability of experiencing unhappiness, regardless of whether individuals had high or low medical spending. Additionally, it decreased the probability of being pretty happy and having high medical expenses, while increasing the
This research paper presents a meta-analysis of the multifaceted role of technology in mental health. The pervasive influence of technology on daily lives necessitates a deep understanding of its impact on mental health services. This study synthesizes literature covering Behavioral Intervention Technologies (BITs), digital mental health interventions during COVID-19, young men's attitudes toward mental health technologies, technology-based interventions for university students, and the applicability of mobile health technologies for individuals with serious mental illnesses. BITs are recognized for their potential to provide evidence-based interventions for mental health conditions, especially anxiety disorders. The COVID-19 pandemic acted as a catalyst for the adoption of digital mental health services, underscoring their crucial role in providing accessible and quality care; however, their efficacy needs to be reinforced by workforce training, high-quality evidence, and digital equity. A nuanced understanding of young men's attitudes toward mental health is imperative for devising effective online services. Technology-based interventions for university students are promising, al
Large Language Models (LLMs) hold promise in addressing complex medical problems. However, while most prior studies focus on improving accuracy and reasoning abilities, a significant bottleneck in developing effective healthcare agents lies in the readability of LLM-generated responses, specifically, their ability to answer public health problems clearly and simply to people without medical backgrounds. In this work, we introduce RephQA, a benchmark for evaluating the readability of LLMs in public health question answering (QA). It contains 533 expert-reviewed QA pairs from 27 sources across 13 topics, and includes a proxy multiple-choice task to assess informativeness, along with two readability metrics: Flesch-Kincaid grade level and professional score. Evaluation of 25 LLMs reveals that most fail to meet readability standards, highlighting a gap between reasoning and effective communication. To address this, we explore four readability-enhancing strategies-standard prompting, chain-of-thought prompting, Group Relative Policy Optimization (GRPO), and a token-adapted variant. Token-adapted GRPO achieves the best results, advancing the development of more practical and user-friendl
The PASTEUR4OA project analyses what makes an Open Access (OA) policy effective. The total number of institutional or funder OA policies worldwide is now 663 (March 2015), over half of them mandatory. ROARMAP, the policy registry, has been rebuilt to record more policy detail and provide more extensive search functionality. Deposit rates were measured for articles in institutions' repositories and compared to the total number of WoS-indexed articles published from those institutions. Average deposit rate was over four times as high for institutions with a mandatory policy. Six positive correlations were found between deposit rates and (1) Must-Deposit; (2) Cannot-Waive-Deposit; (3) Deposit-Linked-to-Research-Evaluation; (4) Cannot-Waive-Rights-Retention; (5) Must-Make-Deposit-OA (after allowable embargo) and (6) Can-Waive-OA. For deposit latency, there is a positive correlation between earlier deposit and (7) Must-Deposit-Immediately as well as with (4) Cannot-Waive-Rights-Retention and with mandate age. There are not yet enough OA policies to test whether still further policy conditions would contribute to mandate effectiveness but the present findings already suggest that it woul
This study introduces an inverse behavioral optimization framework that integrates QALY-based health outcomes, ROI-driven incentives, and adaptive behavioral learning to quantify how policy design shapes national healthcare performance. Building on the FOSSIL (Flexible Optimization via Sample-Sensitive Importance Learning) paradigm, the model embeds a regret-minimizing behavioral weighting mechanism that enables dynamic learning from heterogeneous policy environments. It recovers latent behavioral sensitivities (efficiency, fairness, and temporal responsiveness T) from observed QALY-ROI trade-offs, providing an analytical bridge between individual incentive responses and aggregate system productivity. We formalize this mapping through the proposed System Impact Index (SII), which links behavioral elasticity to measurable macro-level efficiency and equity outcomes. Using OECD-WHO panel data, the framework empirically demonstrates that modern health systems operate near an efficiency-saturated frontier, where incremental fairness adjustments yield stabilizing but diminishing returns. Simulation and sensitivity analyses further show how small changes in behavioral parameters propagate
YouTube has rapidly emerged as a predominant platform for content consumption, effectively displacing conventional media such as television and news outlets. A part of the enormous video stream uploaded to this platform includes health-related content, both from official public health organizations, and from any individual or group that can make an account. The quality of information available on YouTube is a critical point of public health safety, especially when concerning major interventions, such as vaccination. This study differentiates itself from previous efforts of auditing YouTube videos on this topic by conducting a systematic daily collection of posted videos mentioning vaccination for the duration of 3 months. We show that the competition for the public's attention is between public health messaging by institutions and individual educators on one side, and commentators on society and politics on the other, the latest contributing the most to the videos expressing stances against vaccination. Videos opposing vaccination are more likely to mention politicians and publication media such as podcasts, reports, and news analysis, on the other hand, videos in favor are more li
Background: This study aims to evaluate the Chicago Teen Pregnancy Prevention Initiative delivery optimization outcomes given policy-neutral and policy-focused approaches to deliver this program to at-risk teens across the City of Chicago. Methods: We collect and compile several datasets from public sources including: Chicago Department of Public Health clinic locations, two public health statistics datasets, census data of Chicago, list of Chicago public high schools, and their Locations. Our policy-neutral approach will consist of an equal distribution of funds and resources to schools and centers, regardless of past trends and outcomes. The policy-focused approaches will evaluate two models: first, a funding model based on prediction models from historical data; and second, a funding model based on economic and social outcomes for communities. Results: Results of this study confirms our initial hypothesis, that even though the models are optimized from a machine learning perspective, there is still possible that the models will produce wildly different results in the real-world application. Conclusions: When ethics and ethical considerations are extended beyond algorithmic optim
Implementation of digital health systems in low-middle-income countries (LMICs) often fails due to a lack of evaluations that take into account infrastructure limitations, local policies, and community readiness. We introduce HOT-FIT-BR, a contextual evaluation framework that expands the HOT-FIT model with three new dimensions: (1) Infrastructure Index to measure electricity/internet availability, (2) Policy Compliance Layer to ensure regulatory compliance (e.g., Permenkes 24/2022 in Indonesia), and (3) Community Engagement Fit. Simulations at Indonesian Health Centers show that HOT-FIT-BR is 58% more sensitive to detecting problems than HOT-FIT, especially in rural areas with an Infra Index <3. The framework has also proven adaptive to the context of other LMICs such as India and Kenya through local parameter adjustments.
Health research capacity strengthening is of importance to reach health goals. The ARCADE projects' aim was to strengthen health research across Africa and Asia using innovative educational technologies. In the four years of the EU funded projects, challenges also of technical nature were identified. This article reports on a study conducted within the ARCADE projects. The study focused on addressing challenges of video conferencing in resource constrained settings and was conducted using action research. As a result, a plugin for the open source video conferencing system minisip was implemented and evaluated. The study showed that both the audio and video streams could be improved by the introduced plugin, which addressed one technical challenge.
Mobile health apps are revolutionizing the healthcare ecosystem by improving communication, efficiency, and quality of service. In low- and middle-income countries, they also play a unique role as a source of information about health outcomes and behaviors of patients and healthcare workers, while providing a suitable channel to deliver both personalized and collective policy interventions. We propose a framework to study user engagement with mobile health, focusing on healthcare workers and digital health apps designed to support them in resource-poor settings. The behavioral logs produced by these apps can be transformed into daily time series characterizing each user's activity. We use probabilistic and survival analysis to build multiple personalized measures of meaningful engagement, which could serve to tailor content and digital interventions suiting each health worker's specific needs. Special attention is given to the problem of detecting churn, understood as a marker of complete disengagement. We discuss the application of our methods to the Indian and Ethiopian users of the Safe Delivery App, a capacity-building tool for skilled birth attendants. This work represents an
What is the state of the research on crowdsourcing for policy making? This article begins to answer this question by collecting, categorizing, and situating an extensive body of the extant research investigating policy crowdsourcing, within a new framework built on fundamental typologies from each field. We first define seven universal characteristics of the three general crowdsourcing techniques (virtual labor markets, tournament crowdsourcing, open collaboration), to examine the relative trade-offs of each modality. We then compare these three types of crowdsourcing to the different stages of the policy cycle, in order to situate the literature spanning both domains. We finally discuss research trends in crowdsourcing for public policy, and highlight the research gaps and overlaps in the literature. KEYWORDS: crowdsourcing, policy cycle, crowdsourcing trade-offs, policy processes, policy stages, virtual labor markets, tournament crowdsourcing, open collaboration